Pathology: Oesophagus & Mouth Flashcards
What is the GOJ line?
Gastro-oesophageal junction
What does the Z line represent?
Squamo-columnar junction
What are causes of acute oesophagitis and how common is it?
- corrosive due to chemical ingestion
- infective in immunocompromised (e.g.candidiasis, herpes, CMV)
- rare
What is CMV?
Cytomegalovirus (in herpes family)
What are causes of chronic oesophagitis and how common is it?
- reflux oesophagitis
- rare is Crohn’s disease
- common
What is reflux oesophagitis?
Inflammation of the oesophagus due to refluxed low pH gastric content
What can cause oesophagitis?
- defective sphincter function +/- hiatus hernia
- raised intra-abdominal pressure e.g. pregnancy
- abnormal oesophageal motility
What is a hiatus hernia?
Hiatus (opening where oesophagus goes through diaphragm) is larger than normal and part of stomach slips through
How does reflux oesophagitis appear macroscopically?
- red, inflammed oesophagus
- black/purpley oesophagus
How does reflux oesophagitis appear microscopically?
- basal zone epithelial expansion due to increased cell division due to increased cell desquamation (shedding)
- intraepithelial neutrophils, lymphocytes and eosinophils
- elongation of connective tissue papillae
What is Barrett’s Oesophagus?
Replacement of stratified squamous epithelium by columnar epithelium
What are complications of reflux oesophagitis?
- stricture (narrowing)
- ulceration (bleeding)
- Barrett’s Oesophagus
What causes metaplasia of cells in Barrett’s oesophagus?
Persistent reflux of acid/bile
What may the columnar cells come from?
- Expansion of columnar epithelium from gastric glands or from submucosal glands
- From oesophageal stem cells
Why do columnar cells replace squamous in Barrett’s Oesophagus?
They regenerate faster and as a protective response
What is a macroscopic sign of Barrett’s Oesophagus?
Red velvety mucosa in lower oesophagus
What is a microscopic sign of Barrett’s Oesophagus?
Columnar lined mucosa with intestinal metaplasia
What are two results of Barrett’s Oesophagus?
- unstable mucosa (continuing damage)
- increased risk of developing dysplasia and carcinoma of the oesophagus (intestinal metaplasia)
What is another name for allergic oesophagitis?
Eosinophillic oesophagitis
What factors is (age group, sex, medical history, family history) is allergic oesophagitis usually associated with?
- young
- males more than females
- history of asthma
- family history of allergy
What are two clinical findings of allergic oesophagitis?
- raised eosinophils in blood
- pH probe negative for reflux
How does allergic oesophagitis present in endoscopy (macroscopically)?
Corrugated (feline) or spotty oesophagus
How does allergic oesophagitis present microscopically?
Large number of intraepithelial eosinophils
What are possible treatments for allergic oesophagitis?
- steroids
- monteleukast
- chromoglycate
What are the features of benign oesophageal tumours?
- squamous papilloma
- rare
- papillary
- HPV related
- asymptomatic
What are some very rare causes of benign oesophageal tumours?
- leiomyomas
- lipomas
- fibrovascular polyps
- granular cell tumours
From what cells do Leiomyomas grow?
Smooth muscle cells
From what cells do lipomas grow?
Fat cells
From what cells are granular cell tumours thought to grow?
Schwann cells
What are the two types of malignant oesophageal tumours?
- squamous cell carcinoma
- adenocarcinoma
What 6 potential causes of squamous cell carcinoma?
- smoking/alcohol
- Vitamin A, Zinc deficiency
- HPV
- Tannic acid/strong tea
- Oesophagitis
- Genetic
What malignant oesophageal tumour is associated with Barrett’s Oesophagus?
Adenocarcinoma
What can patient with squamous cell carcinoma in the oesophagus present with?
Dysphagia
What are the 3 steps in the pathogenesis of squamous cell carcinoma?
Normal -> GORD -> severe dysplasia
What factors (sex, weight, ethnicity, where in oesophagus) are related to higher risk of adenocarcinoma?
- males
- obese
- caucasian
- lower 1/3
What are the 6 steps in the pathogenesis of adenocarcinoma?
genetic factors, reflux disease -> chronic reflux oesophagitis -> Barrett’s Oesophagus (intestinal metaplasia) -> Low-grade dysplasia -> High-grade dysplasia -> adenocarcinoma
What are the mechanisms of metastases of oesophageal carcinomas and examples of where?
- direct invasion e.g. local invasion
- lymphatic permeation e.g. nodal metastases
- vascular invasion e.g. to liver
How might oesophageal carcinoma present clinically?
- dysphagia
- general malignancy symptoms e.g. weight loss, fatigue, anaemia (due to metastases)
What is a Mallory Weiss tear?
A tear in the mucous membrane often at the gastro-oesophageal junction often caused by excessive coughing/vomiting. Can cause severe GI bleeding.
What are oesophageal varices?
Enlarged blood vessels in oesophagus often due to obstructed blood flow through portal vein
What are most oral carcinomas?
Squamous cell carcinomas
How can oral carcinomas present?
red, white, speckled, lump, ulcer
What are the high risk sites of developing oral carcinomas?
- lateral borders and ventral tongue
- soft palate
- retromolar pad
- tonsillar pillar
- floor of mouth
What are some potential causes of oral carcinoma?
- smoking
- alcohol
- betel quid (tobacco and betel nut chew)
- patient with primary oral SCC at risk of developing secondary oral SCC
- post transplant
- potentially HPV
- potentially chronic infections
What are two variants of oral carcinoma histopathology?
verrucous(warty lesions) and acantholytic (loss of intracellular connections e.g. desmosomes)
How are oral carcinomas graded?
- TNM system
- factors e.g. degree of differentiation, depth and pattern of invasion, lymphovascular invasion etc.
What does TNM stand for?
- T -> greatest diameter of tumour, structures invaded
- N -> lymph node status
- M -> metastasis
What is survival rates of oral carcinoma?
5yr 40% -50%
What is treatment for oral carcinoma?
surgery +/- adjuvant therapy
